Lumbar disc herniation associated with separation of the posterior ring apophysis: analysis of five surgical cases and review of the literature

Asazuma, Takashi; Nobuta, Masuhiro; Sato, Mitsuharu; Yamagishi, Masaaki; Fujikawa, Kyosuke

doi:10.1007/s00701-003-0044-z

Cited by 18 publications

(30 citation statements)

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“…It was frequently found to appear together with other signs of SD [8]. Previous studies reported PBA would occur at the lower lumbar spine at a low incidence and tend to promote symptomatic disc herniation [8,26,27]. The high incidence of PBA in symptomatic TLDH patients may be partly attributed to increased thoracolumbar kyphosis, as observed in this series, which could produce increased stretching stress on the posterior annulus of the discs.…”

Section: Discussionsupporting

confidence: 56%

The relationship of symptomatic thoracolumbar disc herniation and Scheuermann’s disease

Liu

Chen

et al. 2013

Eur Spine J

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Purpose Symptomatic disc herniations in the thoracolumbar spine between T10/11 and L1/2 can be collectively called thoracolumbar disc herniation (TLDH). The etiology of this disorder is unclear. However, it is interesting that we have noted numerous TLDH patients have radiographic features of another spinal disorder which is Scheuermann's disease (SD). The purpose of this study is to investigate the relationship between symptomatic TLDH and SD in a symptomatic TLDH cohort. Methods A cohort of 63 patients with symptomatic TLDH, who had surgery was investigated. Incidences of associated SD and four radiographic signs of SD that were Schmorl's node, irregular vertebral end plate, posterior bony avulsion of the vertebra and wedge-shaped vertebra, average thoracolumbar kyphotic angle and incidences of disc herniation at segments with and without radiographic signs of SD were examined. Data from the TLDH group were compared with 57 patients undergoing surgery for lower lumbar disc herniation (LDH, L3/4-L5/S1) in the same period. Results The incidences of the four radiographic signs of SD and the incidence of associated SD were all significantly higher in the TLDH group than in the LDH group. 95.2 % of the patients in the TLDH group were diagnosed with SD (either classical SD or its atypical form). The average thoracolumbar kyphotic angle of the TLDH group was 16.9°, while that of the LDH group was 7.6°( P = 0.000). In the TLDH group, the incidences of disc herniation at segments with radiographic signs of SD were all significantly higher than at segments where no sign of SD was found. Conclusions The high proportion of associated SD and the tendency of SD's signs to promote disc herniation in symptomatic TLDH patients suggest a close relationship between these two disorders. Symptomatic TLDH should be seen as a truly different surgical entity, that is, a special form of SD rather than just an indicator of a failing back.

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Section: Discussionsupporting

confidence: 56%

The relationship of symptomatic thoracolumbar disc herniation and Scheuermann’s disease

Liu

Chen

et al. 2013

Eur Spine J

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“…Some authors2,5,18) suggested posterolateral arthrodesis to avoid secondary instability. In the high lumbar levels (L1/2, 2/3), our three patients were given extensive laminectomy and one (L1/2 level) was performed posterior lumbar interbody fusion procedure.…”

Section: Discussionmentioning

confidence: 99%

Clinical and Radiologic Analysis of Posterior Apophyseal Ring Separation Associated with Lumbar Disc Herniation

Bae¹,

Rhee²,

Kim³

et al. 2013

J Korean Neurosurg Soc

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ObjectiveWe analyzed the clinical and radiologic features of posterior apophyseal ring separation (PARS) with lumbar disc herniation and suggest the proper management options according to the PARS characteristics.MethodsWe reviewed case series of patients with PARS who underwent surgery of lumbar disc herniation. Preoperative symptoms, neurologic status, Body Mass Index, preoperative and postoperative Visual Analogue Scale (VAS) and Korean-Oswestry Disability Index (K-ODI) scores, operation types were obtained. PARS size, locations, the degree of resection were assessed.ResultsPARS was diagnosed in 109 (7.5%) patients among 1448 patients given surgical treatment for single level lumbar disc herniation. There were 55 (50.5%) small PARS and 54 (49.5%) large PARS. Among the large PARS group, 15 (27.8%) had lower endplate PARS of upper vertebra at the level of disc herniation. Thirty-nine (72.2%) were upper endplate PARS of lower vertebra. Among the group with upper endplate PARS of lower vertebra, unresected PARS was diagnosed in 12 (30.8%) cases and resected PARS was diagnosed in 27 (69.2%) cases. VAS and K-ODI scores changes were 3.6±2.9 and 5.4±6.4 in the unresected PARS group, 5.8±2.1 and 11.3±7.1 in the resected PARS group. The group with upper endplate PARS of lower vertebra showed significant difference of VAS (p=0.01) and K-ODI (p=0.013) score changes between unresected and resected PARS groups.ConclusionThe large PARS of upper endplate in lower vertebra should be removed during the surgery of lumbar disc herniation. High level or bilateral side of PARS should be widely decompressed and arthrodesis procedures are necessary if there is a possibility of secondary instability.

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“…There is some suggestion that removal of the RAF fragment does not necessarily provide better results than if the fragment is left behind [18]. Other studies support the removal of the fracture fragment during surgery to excise the herniated disc [15,16,17,19,20]. Chang et al [12] argued that the decision to perform surgery was dependent on the size of the RAF.…”

Section: Discussionmentioning

confidence: 99%

“…MRI and plain radiographs are not as effective as CT at visualizing RAF [19,23]. Figure 2 illustrates this point by showing a spinal MRI of one our patients with no evidence of RAF, in which RAF was later diagnosed by a comparative CT study.…”

Section: Discussionmentioning

confidence: 99%

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Ring Apophysis Fracture in Pediatric Lumbar Disc Herniation: A Common Entity

et al. 2013

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Background/Aims: Lumbar disc herniation (LDH) can be associated with ring apophysis fracture (RAF), which is found in 6% of adult cases. However, the incidence and management of RAF in pediatric LDH is not well documented. The purpose of this study is to determine the prevalence of RAF in pediatric LDH, identify risk factors and explore the influence of RAF on the surgical management and outcome of LDH patients. Methods: Hospital records and images were retrospectively reviewed for all pediatric patients (<18 years old) who underwent CT scanning for LDH at BC Children's Hospital from 1985 to 2010. Results: Forty-two patients met the study inclusion criteria. RAF was present in 38% of the pediatric patients with LDH. There was a significant correlation with gender (p = 0.021; 55% of the males had RAF, and 20% of the females) and association with central herniations (p = 0.003). At the last follow-up, 58% of the patients with RAF were symptom free, compared with 68% of the patients with no RAF. Conclusion: RAF is more frequently associated with LDH in children than in adults. Gender and central disc herniation are associated with RAF. Given the frequency of RAF, to properly identify these fractures and anticipate their treatment, preoperative CT would be necessary.

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Lumbar disc herniation associated with separation of the posterior ring apophysis: analysis of five surgical cases and review of the literature

Abstract: CT and CT discography (CTD) are the diagnostic tools of choice for detecting this condition. Posterior lumbar interbody fusion (PLIF) is an effective procedure for patients who have low back pain due to lumbar disc herniation accompanied by a separation of the posterior ring apophysis.

Cited by 18 publications

References 0 publications

The relationship of symptomatic thoracolumbar disc herniation and Scheuermann’s disease

The relationship of symptomatic thoracolumbar disc herniation and Scheuermann’s disease

Clinical and Radiologic Analysis of Posterior Apophyseal Ring Separation Associated with Lumbar Disc Herniation

Ring Apophysis Fracture in Pediatric Lumbar Disc Herniation: A Common Entity

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